Lyme Disease Dormancy: Can Bacteria Survive Antibiotics?
CAN LYME DISEASE HIDE FROM TREATMENT?
SOME BACTERIA MAY SLOW DOWN OR GO DORMANT
AND REACTIVATE LATER
Lyme disease dormancy research suggests that some forms of Borrelia burgdorferi may survive treatment by entering low-activity states.
Quick Answer: Laboratory studies suggest Borrelia may enter dormant states—including persister and VBNC forms—that allow survival during antibiotic exposure.
Clinical Insight: These survival strategies may offer one possible explanation for persistent symptoms in some patients, although their exact role in human disease remains under investigation.
Feng and colleagues from Johns Hopkins University identified FDA-approved drug combinations that may be effective against B. burgdorferi persisters in vitro.
Persistence may represent one form of bacterial dormancy. “Evidence suggests dormancy consists of a continuum of interrelated states including viable but nonculturable (VBNC) and persistence states,” according to Mali.
This raises an important question: can dormant bacterial states contribute to ongoing symptoms after treatment?
In addition to dormancy, researchers have also explored Lyme disease biofilm and morphologic forms of Borrelia as another possible mechanism that may contribute to bacterial persistence.
Persister Cells and VBNC States
Mali distinguishes between two key dormant states:
- Persister cells: A small subpopulation that enters a dormant, nondividing state but can resume growth after stress resolves
- VBNC cells: Living cells that cannot grow on routine culture media and may require specific signals to reactivate
Both states may allow bacteria to survive antibiotic exposure while reducing metabolic activity.
Researchers continue to investigate whether these dormant forms contribute to persistent infection, prolonged inflammation, or lingering symptoms in some patients.
Why Dormancy Matters in Lyme Disease
Lyme disease dormancy research raises important questions about treatment response and symptom persistence.
Persister and VBNC cells may coexist, contributing to antibiotic tolerance and reduced bacterial activity under stress conditions.
These findings may offer one possible explanation for why some patients continue to experience symptoms after treatment.
At the same time, researchers continue to debate whether persistent symptoms reflect dormant infection, immune activation, bacterial debris, coinfections, or a combination of mechanisms.
Learn more about post-treatment Lyme disease syndrome and the role of coinfections in persistent illness.
Can Lyme Disease Stay Dormant in the Body?
Patients frequently ask whether Lyme disease can remain dormant for months or years before symptoms reappear.
Laboratory evidence suggests some bacterial forms may survive under stressful conditions by slowing metabolic activity. However, translating these findings into human disease remains challenging.
Some clinicians remain concerned that unresolved infection may contribute to ongoing illness in a subset of patients, while others emphasize immune and inflammatory mechanisms after treatment.
Because symptoms such as fatigue, pain, and cognitive dysfunction overlap with many medical conditions, careful evaluation remains important.
Future Directions
Understanding dormancy may help identify proteins and pathways that regulate bacterial survival states.
This could support development of therapies targeting dormant bacterial forms or improving treatment response.
However, translating laboratory findings into clinical treatment recommendations remains a challenge.
Clinical Perspective
Lyme disease dormancy remains an active area of research.
While in vitro findings are compelling, additional clinical studies are needed to clarify how these mechanisms affect patients.
Patients with persistent symptoms may benefit from evaluation of persistent Lyme disease, review of Lyme disease symptoms, and consideration of interacting mechanisms such as biofilm formation and persister cells.
The Bottom Line
Lyme disease dormancy may allow bacteria to survive antibiotic exposure under certain laboratory conditions.
Whether dormant bacterial forms contribute directly to persistent symptoms in humans remains an area of ongoing debate and investigation.
Understanding dormancy may eventually influence future approaches to diagnosis and treatment.
References
- Mali S, et al. J Bacteriol. 2017.
- Feng J, Auwaerter PG, Zhang Y. PLoS One. 2015.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Obviously.
You don’t reference Kim Lewis’ fantastic work on B. burgdorferi persisters at Northeastern.
I agree. Here is the link to the Northeastern article on persisters.
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